Pub Date : 2024-07-01DOI: 10.1136/bmjonc-2023-000087
Xifeng Wu, Huakang Tu, Qingfeng Hu, Shan-Pou Tsai, David Ta-Wei Chu, C. Wen
To develop and validate machine-learning models that predict the risk of pan-cancer incidence using demographic, questionnaire and routine health check-up data in a large Asian population. This study is a prospective cohort study including 433 549 participants from the prospective MJ cohort including a male cohort (n=208 599) and a female cohort (n=224 950). During an 8-year median follow-up, 5143 cancers occurred in males and 4764 in females. Compared with Lasso-Cox and Random Survival Forests, XGBoost showed superior performance for both cohorts. The XGBoost model with all 155 features in males and 160 features in females achieved an area under the curve (AUC) of 0.877 and 0.750, respectively. Light models with 31 variables for males and 11 variables for females showed comparable performance: an AUC of 0.876 (95% CI 0.858 to 0.894) in the overall population and 0.818 (95% CI 0.795 to 0.841) in those aged ≥40 years in the male cohort and an AUC of 0.746 (95% CI 0.721 to 0.771) in the overall population and 0.641 (95% CI 0.605 to 0.677) in those aged ≥40 years in the female cohort. High-risk individuals have at least ninefold higher risk of pan-cancer incidence compared with low-risk groups. We developed and internally validated the first machine-learning models based on routine health check-up data to predict pan-cancer risk in the general population and achieved generally good discriminatory ability with a small set of predictors. External validation is warranted before the implementation of our risk model in clinical practice.
{"title":"Novel machine learning algorithm in risk prediction model for pan-cancer risk: application in a large prospective cohort","authors":"Xifeng Wu, Huakang Tu, Qingfeng Hu, Shan-Pou Tsai, David Ta-Wei Chu, C. Wen","doi":"10.1136/bmjonc-2023-000087","DOIUrl":"https://doi.org/10.1136/bmjonc-2023-000087","url":null,"abstract":"\u0000\u0000To develop and validate machine-learning models that predict the risk of pan-cancer incidence using demographic, questionnaire and routine health check-up data in a large Asian population.\u0000\u0000\u0000\u0000This study is a prospective cohort study including 433 549 participants from the prospective MJ cohort including a male cohort (n=208 599) and a female cohort (n=224 950).\u0000\u0000\u0000\u0000During an 8-year median follow-up, 5143 cancers occurred in males and 4764 in females. Compared with Lasso-Cox and Random Survival Forests, XGBoost showed superior performance for both cohorts. The XGBoost model with all 155 features in males and 160 features in females achieved an area under the curve (AUC) of 0.877 and 0.750, respectively. Light models with 31 variables for males and 11 variables for females showed comparable performance: an AUC of 0.876 (95% CI 0.858 to 0.894) in the overall population and 0.818 (95% CI 0.795 to 0.841) in those aged ≥40 years in the male cohort and an AUC of 0.746 (95% CI 0.721 to 0.771) in the overall population and 0.641 (95% CI 0.605 to 0.677) in those aged ≥40 years in the female cohort. High-risk individuals have at least ninefold higher risk of pan-cancer incidence compared with low-risk groups.\u0000\u0000\u0000\u0000We developed and internally validated the first machine-learning models based on routine health check-up data to predict pan-cancer risk in the general population and achieved generally good discriminatory ability with a small set of predictors. External validation is warranted before the implementation of our risk model in clinical practice.\u0000","PeriodicalId":505335,"journal":{"name":"BMJ Oncology","volume":"70 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1136/bmjonc-2024-000404
Sierra Silverwood, Grant Backer, Annie Galloway, Katrina Reid, Anna Jeter, Margo Harrison
Early detection of ovarian cancer can improve patient outcomes; however, screening tests can yield false-positive results, leading to unnecessary surgical interventions. This systematic review explores the prevalence of false-positive ovarian cancer screenings and subsequent unnecessary surgical interventions.Five databases were searched in March 2023 and again in March 2024, encompassing primary literature published between 2003 and 2024. Data collection focused on studies reporting the number of surgical interventions resulting from a false-positive screening result. Studies were categorized by patient risk (average vs high). Studies lacking screening or surgical intervention data, those in which the screening did not directly influence surgical decisions, or those not in English were excluded.Of the 12 papers included, the majority were cohort studies (75%) based in the USA (66%). The primary screening methods included Cancer antigen 125 and transvaginal ultrasound scanning. Patients were stratified by risk, with four studies focused on high-risk populations and eight in average-risk populations. The false-positive and surgical screening rates exhibited significant variability, regardless of risk (0.1%–23.3% and 0%–54.9%, respectively). Complications associated with unnecessary surgical interventions, such as perforation, blood loss and bowel injury, were only reported in four studies. No studies examined the effect these interventions had on patients’ quality of life or directly reported the associated costs of these interventions.This review highlights the significant variability in ovarian cancer screening results, which lead to unnecessary and invasive surgical procedures causing complications such as perforation, blood loss and bowel injury.
{"title":"Assessing the rates of false-positive ovarian cancer screenings and surgical interventions associated with screening tools: a systematic review","authors":"Sierra Silverwood, Grant Backer, Annie Galloway, Katrina Reid, Anna Jeter, Margo Harrison","doi":"10.1136/bmjonc-2024-000404","DOIUrl":"https://doi.org/10.1136/bmjonc-2024-000404","url":null,"abstract":"Early detection of ovarian cancer can improve patient outcomes; however, screening tests can yield false-positive results, leading to unnecessary surgical interventions. This systematic review explores the prevalence of false-positive ovarian cancer screenings and subsequent unnecessary surgical interventions.Five databases were searched in March 2023 and again in March 2024, encompassing primary literature published between 2003 and 2024. Data collection focused on studies reporting the number of surgical interventions resulting from a false-positive screening result. Studies were categorized by patient risk (average vs high). Studies lacking screening or surgical intervention data, those in which the screening did not directly influence surgical decisions, or those not in English were excluded.Of the 12 papers included, the majority were cohort studies (75%) based in the USA (66%). The primary screening methods included Cancer antigen 125 and transvaginal ultrasound scanning. Patients were stratified by risk, with four studies focused on high-risk populations and eight in average-risk populations. The false-positive and surgical screening rates exhibited significant variability, regardless of risk (0.1%–23.3% and 0%–54.9%, respectively). Complications associated with unnecessary surgical interventions, such as perforation, blood loss and bowel injury, were only reported in four studies. No studies examined the effect these interventions had on patients’ quality of life or directly reported the associated costs of these interventions.This review highlights the significant variability in ovarian cancer screening results, which lead to unnecessary and invasive surgical procedures causing complications such as perforation, blood loss and bowel injury.","PeriodicalId":505335,"journal":{"name":"BMJ Oncology","volume":"307 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1136/bmjonc-2024-000407
Nina Liebenberg, Alan McWilliam, Sarah L Kerns, Deborah C Marshall, C. West
There is sometimes concern over the use of radiotherapy for cancer in individuals with rheumatoid arthritis (RA), but there is little evidence to support its avoidance. Identifying any association between RA and risk of radiotherapy toxicity could impact current guidance. We aimed to review the evidence base. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, a systematic review was conducted of Medline, Embase and PubMed databases on 25 November 2019 and updated 22 February 2024. Articles identified for inclusion were reviewed by two independent assessors. 155 articles were identified. With repeat articles excluded, 114 remained. 12 articles were included in qualitative analysis. Six studies held no comparison cohort; one compared patients with RA to patients without RA collagen vascular disease (CVD); five compared patients with RA to CVD or a matched pair. Studies showed patients with RA developed higher levels of toxicity; however, only two studies had statistically significant results. Nine of the 12 studies had medium-to-low quality evidence and displayed predisposition to numerous biases. Due to limited high-quality research, it is difficult to draw a clear conclusion on the relationship between RA and radiotherapy toxicity. Given the current lack of strong and high-quality evidence identified in this review, dose reduction of radiotherapy in patients with RA lacks sufficient evidence to be recommended. There is a need for further high-quality research involving prospective analyses of toxicity, up-to-date radiotherapy techniques, long follow-up and large cohorts. Also, analyses need to adjust for confounding factors, match for risk factors and incorporate RA activity status assessments.
{"title":"Association between rheumatoid arthritis and risk of radiotherapy toxicity: a systematic review","authors":"Nina Liebenberg, Alan McWilliam, Sarah L Kerns, Deborah C Marshall, C. West","doi":"10.1136/bmjonc-2024-000407","DOIUrl":"https://doi.org/10.1136/bmjonc-2024-000407","url":null,"abstract":"There is sometimes concern over the use of radiotherapy for cancer in individuals with rheumatoid arthritis (RA), but there is little evidence to support its avoidance. Identifying any association between RA and risk of radiotherapy toxicity could impact current guidance. We aimed to review the evidence base. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, a systematic review was conducted of Medline, Embase and PubMed databases on 25 November 2019 and updated 22 February 2024. Articles identified for inclusion were reviewed by two independent assessors. 155 articles were identified. With repeat articles excluded, 114 remained. 12 articles were included in qualitative analysis. Six studies held no comparison cohort; one compared patients with RA to patients without RA collagen vascular disease (CVD); five compared patients with RA to CVD or a matched pair. Studies showed patients with RA developed higher levels of toxicity; however, only two studies had statistically significant results. Nine of the 12 studies had medium-to-low quality evidence and displayed predisposition to numerous biases. Due to limited high-quality research, it is difficult to draw a clear conclusion on the relationship between RA and radiotherapy toxicity. Given the current lack of strong and high-quality evidence identified in this review, dose reduction of radiotherapy in patients with RA lacks sufficient evidence to be recommended. There is a need for further high-quality research involving prospective analyses of toxicity, up-to-date radiotherapy techniques, long follow-up and large cohorts. Also, analyses need to adjust for confounding factors, match for risk factors and incorporate RA activity status assessments.","PeriodicalId":505335,"journal":{"name":"BMJ Oncology","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1136/bmjonc-2024-000429
Rick Bangs
{"title":"Addressing the hidden toxicities of cancer: a call to action for clinicians, researchers and clinical trialists","authors":"Rick Bangs","doi":"10.1136/bmjonc-2024-000429","DOIUrl":"https://doi.org/10.1136/bmjonc-2024-000429","url":null,"abstract":"","PeriodicalId":505335,"journal":{"name":"BMJ Oncology","volume":"9 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141392248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1136/bmjonc-2023-000181
M. Tucker, Yu-Wei Chen, Martin H Voss, Bradley A McGregor, M. Bilen, Marc-Oliver Grimm, Paul Nathan, C. Kollmannsberger, Yoshihiko Tomita, Bo Huang, Robert Amezquita, M. Mariani, A. di Pietro, Brian Rini
We report post hoc analyses of efficacy with first-line avelumab plus axitinib or sunitinib according to baseline neutrophil-to-eosinophil ratio (NER) in patients with advanced renal cell carcinoma (aRCC) from the JAVELIN Renal 101 phase 3 trial.Progression-free survival (PFS), overall survival (OS) and objective response per baseline NER were analysed in the overall population and in patients with programmed death ligand 1 (PD-L1+) tumours. Multivariable Cox regression analyses to assess the effect of NER after adjustment for other baseline variables were conducted.In NER
我们报告了根据基线中性粒细胞与嗜酸性粒细胞比率（NER）对JAVELIN肾101 3期试验中晚期肾细胞癌（aRCC）患者一线阿维单抗联合阿西替尼或舒尼替尼疗效进行的事后分析。我们分析了总体人群和程序性死亡配体1（PD-L1+）肿瘤患者的无进展生存期（PFS）、总生存期（OS）和基线NER客观反应。在NER<中位数与≥中位数的阿维单抗加阿西替尼治疗组亚组中，PFS和OS的HR分别为0.81（95% CI 0.630~1.035）和0.67（95% CI 0.481~0.940），客观反应率（ORR）分别为63.9% vs 55.2%。PD-L1+亚组的PFS HR为0.72（95% CI 0.520至0.986）。比较舒尼替尼治疗组中的NER定义亚组，PFS和OS的HR分别为0.93（95% CI 0.728至1.181）和0.57（95% CI 0.424至0.779），ORR分别为32.8%和30.8%。在NER亚组中，PFS、OS和ORR分析结果显示，阿维单抗联合阿西替尼治疗优于舒尼替尼治疗。当NER被评估为二分变量（中位数截点）或连续变量时，评估治疗与NER之间关系的交互检验产生了相互矛盾的结果。假设生成分析表明，无论治疗与否，基线NER可能是延长OS的预后因素。NCT02684006.NCT02684006.NCT02684006.NCT02684006.NCT02684006.NCT02684006.NCT02684006.NCT02684006.NCT02684006.
{"title":"Association between neutrophil-to-eosinophil ratio and efficacy outcomes with avelumab plus axitinib or sunitinib in patients with advanced renal cell carcinoma: post hoc analyses from the JAVELIN Renal 101 trial","authors":"M. Tucker, Yu-Wei Chen, Martin H Voss, Bradley A McGregor, M. Bilen, Marc-Oliver Grimm, Paul Nathan, C. Kollmannsberger, Yoshihiko Tomita, Bo Huang, Robert Amezquita, M. Mariani, A. di Pietro, Brian Rini","doi":"10.1136/bmjonc-2023-000181","DOIUrl":"https://doi.org/10.1136/bmjonc-2023-000181","url":null,"abstract":"We report post hoc analyses of efficacy with first-line avelumab plus axitinib or sunitinib according to baseline neutrophil-to-eosinophil ratio (NER) in patients with advanced renal cell carcinoma (aRCC) from the JAVELIN Renal 101 phase 3 trial.Progression-free survival (PFS), overall survival (OS) and objective response per baseline NER were analysed in the overall population and in patients with programmed death ligand 1 (PD-L1+) tumours. Multivariable Cox regression analyses to assess the effect of NER after adjustment for other baseline variables were conducted.In NER <median versus ≥median subgroups of the avelumab plus axitinib arm, HRs for PFS and OS were 0.81 (95% CI 0.630 to 1.035) and 0.67 (95% CI 0.481 to 0.940), and objective response rates (ORRs) were 63.9% vs 55.2%, respectively. The HR for PFS in the PD-L1+ subgroup was 0.72 (95% CI 0.520 to 0.986). Comparing NER-defined subgroups in the sunitinib arm, HRs for PFS and OS were 0.93 (95% CI 0.728 to 1.181) and 0.57 (95% CI 0.424 to 0.779), and ORRs were 32.8% versus 30.8%, respectively. Within NER subgroups, analyses of PFS, OS and ORR favoured avelumab plus axitinib versus sunitinib treatment. Interaction tests that assessed the association between treatment and NER yielded conflicting results when NER was assessed as a dichotomised variable (median cut-off) or continuous variable.Hypothesis-generating analyses suggest that baseline NER may be prognostic for longer OS irrespective of treatment. Analyses of the association between NER level and treatment outcomes with avelumab plus axitinib versus sunitinib were inconclusive.NCT02684006.","PeriodicalId":505335,"journal":{"name":"BMJ Oncology","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141407062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1136/bmjonc-2023-000158
Kuan Liao, David C Wong, Fabio Gomes, Corinne Faivre-Finn, Laura Moliner, Matthew Sperrin, Janelle Yorke, Sabine van der Veer
Investigate whether routinely collected electronic patient-reported outcome measures (ePROMs) add prognostic value to clinical and tumour characteristics for adults with advanced non-small cell lung cancer (NSCLC) receiving immunotherapy.We retrospectively analysed data from adults with advanced NSCLC commencing immunotherapy between April 2019 and June 2022. Prognostic factors were ePROMs on quality of life (EuroQoL five-dimension five-level (EQ-5D-5L); EuroQoL Visual Analogue Scale (EQ-VAS)) and symptoms (patient-reported version of the Common Terminology Criteria for Adverse Events v5.0) completed at baseline and the first follow-up. We performed Cox proportional hazard regression for overall survival and time-to-progression as outcomes, and logistic regression for the onset of severe treatment toxicities (grade ≥3).We included 379 patients; 161 (42.5%) completed ePROMs at baseline. Median overall survival and time-to-progression were 13.5 months (95% CI 11.3 to 16.7) and 10.5 months (95% CI 8.8 to 13.7), respectively. 36 (9.5%) experienced severe treatment toxicities during follow-up. Patients with lower EQ-5D-5L utility scores (HR per 0.1 unit increase 0.84, 95% CI 0.74 to 0.95) and higher symptom burden (HR 1.11; 95% CI 1.04 to 1.19) had poorer overall survival. This was also true for those with decreased EQ-VAS and increased symptom burden between baseline and the first follow-up. Lastly, only decreased EQ-5D-5L utility scores between baseline and the first follow-up were associated with shorter time-to-progression.ePROMs may add prognostic value to clinical and tumour characteristics for overall survival in adults with advanced NSCLC receiving immunotherapy.
我们对2019年4月至2022年6月期间开始接受免疫疗法的晚期非小细胞肺癌（NSCLC）成人患者的数据进行了回顾性分析。预后因素是在基线和首次随访时完成的关于生活质量（EuroQoL五维五级（EQ-5D-5L）；EuroQoL视觉模拟量表（EQ-VAS））和症状（患者报告版不良事件通用术语标准v5.0）的ePROM。我们对总生存期和病情进展时间进行了Cox比例危害回归，并对严重治疗毒性（≥3级）的发生进行了Logistic回归。我们纳入了379名患者，其中161人（42.5%）在基线时完成了ePROM。中位总生存期和进展时间分别为 13.5 个月（95% CI 11.3 至 16.7）和 10.5 个月（95% CI 8.8 至 13.7）。36例（9.5%）患者在随访期间出现严重的治疗毒性反应。EQ-5D-5L效用评分较低（每增加0.1个单位的HR为0.84，95% CI为0.74至0.95）和症状负担较重（HR为1.11；95% CI为1.04至1.19）的患者总生存率较低。从基线到首次随访期间，EQ-VAS下降和症状负担加重的患者也是如此。最后，只有基线至首次随访期间EQ-5D-5L效用评分降低的患者才与较短的病情进展时间相关。
{"title":"Exploring the value of routinely collected data on EQ-5D-5L and other electronic patient-reported outcome measures as prognostic factors in adults with advanced non-small cell lung cancer receiving immunotherapy","authors":"Kuan Liao, David C Wong, Fabio Gomes, Corinne Faivre-Finn, Laura Moliner, Matthew Sperrin, Janelle Yorke, Sabine van der Veer","doi":"10.1136/bmjonc-2023-000158","DOIUrl":"https://doi.org/10.1136/bmjonc-2023-000158","url":null,"abstract":"Investigate whether routinely collected electronic patient-reported outcome measures (ePROMs) add prognostic value to clinical and tumour characteristics for adults with advanced non-small cell lung cancer (NSCLC) receiving immunotherapy.We retrospectively analysed data from adults with advanced NSCLC commencing immunotherapy between April 2019 and June 2022. Prognostic factors were ePROMs on quality of life (EuroQoL five-dimension five-level (EQ-5D-5L); EuroQoL Visual Analogue Scale (EQ-VAS)) and symptoms (patient-reported version of the Common Terminology Criteria for Adverse Events v5.0) completed at baseline and the first follow-up. We performed Cox proportional hazard regression for overall survival and time-to-progression as outcomes, and logistic regression for the onset of severe treatment toxicities (grade ≥3).We included 379 patients; 161 (42.5%) completed ePROMs at baseline. Median overall survival and time-to-progression were 13.5 months (95% CI 11.3 to 16.7) and 10.5 months (95% CI 8.8 to 13.7), respectively. 36 (9.5%) experienced severe treatment toxicities during follow-up. Patients with lower EQ-5D-5L utility scores (HR per 0.1 unit increase 0.84, 95% CI 0.74 to 0.95) and higher symptom burden (HR 1.11; 95% CI 1.04 to 1.19) had poorer overall survival. This was also true for those with decreased EQ-VAS and increased symptom burden between baseline and the first follow-up. Lastly, only decreased EQ-5D-5L utility scores between baseline and the first follow-up were associated with shorter time-to-progression.ePROMs may add prognostic value to clinical and tumour characteristics for overall survival in adults with advanced NSCLC receiving immunotherapy.","PeriodicalId":505335,"journal":{"name":"BMJ Oncology","volume":"295 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141144510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1136/bmjonc-2024-000320
Neil Ryan, M. Glaire, Thomas Walker, N. T. ter Haar, M. Ijsselsteijn, James Bolton, Noel de Miranda, Gareth Evans, David N Church, Tjalling Bosse, E. Crosbie
To explore the impact of molecular subtype in endometrial cancer (EC) on CD8+T cell densities. Furthermore, this work will test the assumption that all mismatch repair deficient (MMRd) tumours are immunologically similar which would enable current trial data to be generalised to all MMRd ECs.All tumours were characterised into the four clinical molecular subtypes. For analysis, theTP53mutant and no-specific molecular profile tumours were grouped together and described as the low mutational burden (LMB) cohort. CD8+T cell counts were taken from four regions of interest which sampled the tumour-stromal interface and the tumour core. CD8+T cell counts were analysed as mean averages.In total, 607 ECs contributed to the analysis. CD8+T cell counts in confirmed Lynch syndrome (LS) ECs were significantly higher thanMLH1-methylated ECs in all tumour locations excluding the tumour stroma. Confirmed LS and path_POLEECs had significantly higher CD8+T cell counts across all tumour locations when compared with LMB ECs. There were limited significant differences in CD8+T cell counts between path_POLEversus confirmed LS ECs. There was no significant difference in the CD8+T cells counts and gene (MLH1,MSH2,MSH6,PMS2) in which the LS pathogenic variant was found; however, this analysis was limited by small numbers.These data indicate that CD8+T cell numbers and distribution is not equal betweenMLH1-methylated and confirmed LS ECs. This is relevant when interpreting current trial data looking to the application of checkpoint inhibition treatments in MMRd cancers.
{"title":"Patterns of cytotoxic T-cell densities in immunogenic endometrial cancers reveal a potential mechanism for differences in immunotherapy efficacy","authors":"Neil Ryan, M. Glaire, Thomas Walker, N. T. ter Haar, M. Ijsselsteijn, James Bolton, Noel de Miranda, Gareth Evans, David N Church, Tjalling Bosse, E. Crosbie","doi":"10.1136/bmjonc-2024-000320","DOIUrl":"https://doi.org/10.1136/bmjonc-2024-000320","url":null,"abstract":"To explore the impact of molecular subtype in endometrial cancer (EC) on CD8+T cell densities. Furthermore, this work will test the assumption that all mismatch repair deficient (MMRd) tumours are immunologically similar which would enable current trial data to be generalised to all MMRd ECs.All tumours were characterised into the four clinical molecular subtypes. For analysis, theTP53mutant and no-specific molecular profile tumours were grouped together and described as the low mutational burden (LMB) cohort. CD8+T cell counts were taken from four regions of interest which sampled the tumour-stromal interface and the tumour core. CD8+T cell counts were analysed as mean averages.In total, 607 ECs contributed to the analysis. CD8+T cell counts in confirmed Lynch syndrome (LS) ECs were significantly higher thanMLH1-methylated ECs in all tumour locations excluding the tumour stroma. Confirmed LS and path_POLEECs had significantly higher CD8+T cell counts across all tumour locations when compared with LMB ECs. There were limited significant differences in CD8+T cell counts between path_POLEversus confirmed LS ECs. There was no significant difference in the CD8+T cells counts and gene (MLH1,MSH2,MSH6,PMS2) in which the LS pathogenic variant was found; however, this analysis was limited by small numbers.These data indicate that CD8+T cell numbers and distribution is not equal betweenMLH1-methylated and confirmed LS ECs. This is relevant when interpreting current trial data looking to the application of checkpoint inhibition treatments in MMRd cancers.","PeriodicalId":505335,"journal":{"name":"BMJ Oncology","volume":"44 36","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141142383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1136/bmjonc-2024-000337
Peter W M Johnson
{"title":"Updating the NHS cancer waiting time standards","authors":"Peter W M Johnson","doi":"10.1136/bmjonc-2024-000337","DOIUrl":"https://doi.org/10.1136/bmjonc-2024-000337","url":null,"abstract":"","PeriodicalId":505335,"journal":{"name":"BMJ Oncology","volume":"93 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140276392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1136/bmjonc-2023-000125
M. Mutebi, N. Aryeetey, Haimanot Kasahun Alemu, L. Carson, Zainab Mohamed, Zainab Doleeb, Nwamaka N Lasebikan, N. Dharsee, S. Msadabwe, Doreen Ramogola-Masire, Sitna N Mwanzi, Khadija Warfa, Emmanuella Nwachukwu, E.S. Woldetsadik, Hirondina Vaz Borges Spencer, N. Chraiet, Matthew Jalink, R. Jagsi, D. Lombe, V. Vanderpuye, Nazik Hammad
Recent studies have identified challenges facing women oncologists in Western contexts. However, similar studies in Africa have yet to be conducted. This study sought to determine the most common and substantial challenges faced by women oncologists in Africa and identify potential solutions.A panel of 29 women oncologists from 20 African countries was recruited through professional and personal networks. A Delphi consensus process identified challenges faced by women oncologists in Africa, and potential solutions. Following this, focus group discussions were held to discuss the results. Descriptive statistics were used to identify the most common challenges indicated by participants and thematic analysis was conducted on focus group transcripts.African women oncologists experienced challenges at individual, interpersonal, institutional and societal levels. The top-ranked challenge identified in the Delphi study was ‘pressure to maintain a work–family balance and meet social obligations’. Some of the challenges identified were similar to those in studies on women oncologists outside of Africa while others were unique to this African demographic. Solutions to improve the experience of women oncologists were identified and discussed, including greater work flexibility and mentorship opportunities.Women oncologists in Africa experience many of the challenges that have been previously identified by studies in other regions. These challenges and potential solutions exist at all levels of the social-ecological framework. Women oncologists must be empowered in number and leadership, and gender-sensitive curricula and competencies must be implemented. A systems-level dialogue could bring light to these challenges and foster tangible action and policy-level changes.
{"title":"Challenges faced by women oncologists in Africa: a mixed methods study","authors":"M. Mutebi, N. Aryeetey, Haimanot Kasahun Alemu, L. Carson, Zainab Mohamed, Zainab Doleeb, Nwamaka N Lasebikan, N. Dharsee, S. Msadabwe, Doreen Ramogola-Masire, Sitna N Mwanzi, Khadija Warfa, Emmanuella Nwachukwu, E.S. Woldetsadik, Hirondina Vaz Borges Spencer, N. Chraiet, Matthew Jalink, R. Jagsi, D. Lombe, V. Vanderpuye, Nazik Hammad","doi":"10.1136/bmjonc-2023-000125","DOIUrl":"https://doi.org/10.1136/bmjonc-2023-000125","url":null,"abstract":"Recent studies have identified challenges facing women oncologists in Western contexts. However, similar studies in Africa have yet to be conducted. This study sought to determine the most common and substantial challenges faced by women oncologists in Africa and identify potential solutions.A panel of 29 women oncologists from 20 African countries was recruited through professional and personal networks. A Delphi consensus process identified challenges faced by women oncologists in Africa, and potential solutions. Following this, focus group discussions were held to discuss the results. Descriptive statistics were used to identify the most common challenges indicated by participants and thematic analysis was conducted on focus group transcripts.African women oncologists experienced challenges at individual, interpersonal, institutional and societal levels. The top-ranked challenge identified in the Delphi study was ‘pressure to maintain a work–family balance and meet social obligations’. Some of the challenges identified were similar to those in studies on women oncologists outside of Africa while others were unique to this African demographic. Solutions to improve the experience of women oncologists were identified and discussed, including greater work flexibility and mentorship opportunities.Women oncologists in Africa experience many of the challenges that have been previously identified by studies in other regions. These challenges and potential solutions exist at all levels of the social-ecological framework. Women oncologists must be empowered in number and leadership, and gender-sensitive curricula and competencies must be implemented. A systems-level dialogue could bring light to these challenges and foster tangible action and policy-level changes.","PeriodicalId":505335,"journal":{"name":"BMJ Oncology","volume":"91 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1136/bmjonc-2024-000327
C. Poole
{"title":"Embracing rapid learning in radiotherapy: feasible and acceptable with stakeholder corroboration","authors":"C. Poole","doi":"10.1136/bmjonc-2024-000327","DOIUrl":"https://doi.org/10.1136/bmjonc-2024-000327","url":null,"abstract":"","PeriodicalId":505335,"journal":{"name":"BMJ Oncology","volume":"306 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140283320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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